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Reconstruction for chronic Achilles tendinopathy: comparison of flexor hallucis longus (FHL) transfer versus V-Y advancement

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Abstract

Background

Several operative techniques exist for Achilles tendinopathy. The purpose of our study was to compare the clinical and functional outcomes of flexor hallucis longus (FHL) transfer and V-Y advancement for the treatment of chronic insertional Achilles tendinopathy.

Methods

Retrospective chart review from 2010 to 2016 of patients that underwent FHL transfer or V-Y advancement for chronic insertional Achilles tendinopathy. Outcome measures were compared for these two procedures.

Results

In total, 46 patients (49 ankles) with a mean age of 55.0 (range 33–73) years. Mean follow-up time 44.7 +/− 25.5 months. FHL group had 21 patients (21 ankles) with 89% satisfaction, 14% complication rate, final VAS of 0.4, final VISA-A of 89.1, subjective strength improvement following surgery of 78%, and 94% would recommend the procedure. V-Y group had 25 patients (28 ankles) with 74% subjective satisfaction, 21% complication rate, final VAS of 1.4, final VISA-A of 78.4, subjective strength improvement following surgery of 67%, and 84% would recommend the procedure. There was no significant difference in any of the results rates between the two groups (p > .05).

Conclusion

V-Y advancement is comparable to FHL transfer for the operative management of insertional Achilles tendinopathy. Though our results trend towards less satisfactory results following V-Y advancement, we found high satisfaction rates with similar functional outcomes and complication rates in both operative groups. We suggest considering V-Y advancement as a viable option for the primary treatment of chronic insertional Achilles tendinopathy in patients who may not be an ideal candidate for FHL transfer.

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Acknowledgements

This work was presented at the Alabama Orthopaedic Society (AOS) 2017 but never published in the final form. We would also like to thank Girish Motwani, M.D., for his contributions to this research.

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Authors and Affiliations

  1. University of Alabama at Birmingham, 1313 13th Avenue South, Suite 207, Birmingham, AL, 35205, USA

    Jackson R. Staggers, Kenneth Smith, Cesar de C. Netto, Sameer Naranje, Krishna Prasad & Ashish Shah

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  1. Jackson R. Staggers
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  2. Kenneth Smith
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  3. Cesar de C. Netto
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  4. Sameer Naranje
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  5. Krishna Prasad
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Correspondence to Ashish Shah.

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The authors declare that they have no conflict of interest.

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Institutional review board approval was obtained prior to this study.

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Staggers, J.R., Smith, K., de C. Netto, C. et al. Reconstruction for chronic Achilles tendinopathy: comparison of flexor hallucis longus (FHL) transfer versus V-Y advancement. International Orthopaedics (SICOT) 42, 829–834 (2018). https://doi.org/10.1007/s00264-018-3834-x

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